Frozen shoulder: symptoms, diagnosis, treatments and self-care

Stiffness, pain and a limited range of movement in the shoulder may be caused by frozen shoulder, or adhesive capsulitis, as it is termed medically.

If you're over 50, it's quite likely you know of someone who's had frozen shoulder – and that’s because, according to a survey,* 72% of patients are over the age of 50.

What is frozen shoulder?

Frozen shoulder syndrome occurs when ligaments around the shoulder joint swell and stiffen to such an extent that normal healing doesn't take place. This makes it difficult to move the shoulder, making everyday activities such as getting dressed or reaching for a cup from a shelf painful. As the condition progresses, the stiffness may continue to the point where range of motion can be severely limited.

Research has shown that diabetes patients are more than twice as likely to suffer with the condition, and other risk factors include recent surgery, having a stroke, overactive or underactive thyroid and heart disease.

If you suspect that you have frozen shoulder, see your GP for a diagnosis. Your doctor should also rule out shoulder arthritis via a scan or X-ray, as it produces similar symptoms. With frozen shoulder the surfaces of your shoulder joint are normal and motion is limited because the tissues surrounding the joint have become tight, preventing you from moving your arm and shoulder as you usually would. With shoulder arthritis the joint surface is damaged.

Learn more about arthritis

What causes frozen shoulder?

Because frozen shoulder is a catch-all term, one person's symptoms and causes might be slightly different from another's, making it difficult to say what has caused the problem.

Frozen shoulder does, however, seem linked to certain activities. For example, any activity that involves you having to rotate your arm, such as freestyle swimming or throwing a ball overarm (for cricket, for example). Also, overhead weight lifting and sudden stress to the shoulder muscles via injury.

It's thought that frozen shoulder is caused by inflammation in the joint - this inflammation could arise after an injury but also as a side effect of other illnesses, such as diabetes, a known risk factor for frozen shoulder.

Frozen shoulder symptoms

• A feeling of pain and tightness in the shoulder area.
• A feeling of tightness especially when putting the arm up and back, as you would do if you were throwing a ball overarm.
• Pain on the back of the wrist. (This specifically relates to frozen shoulder caused by subscapularis trigger points.)
• As time goes on, the symptoms will worsen although the pain may be reduced.

Frozen shoulder treatment

Patients can take anti-inflammatories and painkillers to help with the pain. Most patients with frozen shoulder respond well to home exercises when they are done regularly. (See below for details on stretches and exercises to do at home.)

Physiotherapy is offered to patients with frozen shoulder, providing them with exercises they can use at home as well as helping to stretch and loosen the muscles during regular sessions with a professional.

If a patient has done regular exercises and seen no improvement, a doctor may recommend going under anaesthetic in order to have the muscles and joints manipulated (massaged and stretched).

Another option is to try injecting corticosteroids to the affected area. Some patients may find this is all that's needed to relieve pain and improve movement.

If manipulation under anaesthetic and corticosteroid injections aren't successful, your doctor may suggest surgery, although this is only in severe cases. Corrective surgery works to loosen the tissues surrounding the joint.

Many patients may prefer to seek out non-invasive treatments before going down the more drastic surgical route. Some patients have found acupuncture to be effective, even though, as yet, research hasn't shown that it produces significant results for all patients with frozen shoulder. Acupuncture works by pinpointing certain pressure points on the body, thereby reducing inflammation.

Another non-invasive treatment that has shown particular promise is the Niel Asher Technique. Research from Cambridge University Hospitals looked at the Niel Asher Technique (NAT) – a method involving the manipulation of muscle tissues and joints, applying pressure and stretching – and found that it was more effective than standard physiotherapy. The researchers found that range of motion for FSS patients undergoing NAT treatment improved by 52 degrees, compared to 24 degrees for standard physiotherapy and 0.8 for placebo treatment. The NAT method also gave patients greater strength and power than physiotherapy.

Unlike physiotherapy NAT treatment is applied with the intention of ‘resetting’ the brain with regard to its nerve impulses to the injured area. The idea behind this is that with frozen shoulder the brain has effectively cut off nerve signalling to the area which is why healing isn’t taking place. The manipulations of the shoulder joint and tissues are designed to target nerve receptors so that signalling to the brain is increased and healing can begin. More research is needed, however, to identify why the NAT treatment is more effective than standard physiotherapy and from there, treatment could potentially be refined further.

What can I do about frozen shoulder right now?

Take painkillers 

Taking painkillers will obviously help reduce the symptoms you're experiencing but that won't resolve the issue. There are, however, some things you can try yourself at home.

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Keep moving

Gentle movement is key to improving the symptoms of frozen shoulder. So while you don't want to put yourself through painful motions, you need to make sure you are stretching and moving regularly.

How massage can help frozen shoulder

It needn't be from a qualified masseuse, although that's ideal, a partner or a friend can also help by gently rubbing the affected shoulder, as well as your arm and neck. Increasing circulation to the area should help alleviate the symptoms to some degree.

Use heat to help your frozen shoulder

Applying a warm compress to the area can help a great deal in alleviating pain and also increasing blood flow to the area, thereby potentially helping the body heal.

Be aware of posture

If you're in the early stages of frozen shoulder bad posture can make it worse. Make sure you're sitting in a good position when you're working at a desk or reading or while watching TV on the sofa. "When you're standing, try to keep your arms away from your body by hooking your thumbs into your belt loops or pockets," says Sara Calabro, founding editor of AcuTake. This could help prevent the symptoms worsening.

Sleep with two pillows

One pillow is for your head, as usual, the other is to go between your elbow and your body (on your affected side) so that your arm is held slightly away from your body. "This abducts the arm away from the body, which stretches the subscapularis muscle," says Calabro. If you usually sleep on the side where you have no pain, put the pillow in front of you and hug it, to help keep your arm away from your body.

Exercises for frozen shoulder

There are various stretches you can try to ease your symptoms, but do consult your doctor first. For example:

Hanging arm: Put your good hand on a table or countertop in front of you (at around hip or thigh height). Lean forward so that your 'bad' arm hangs down. Then gently rotate your hips as though trying to spin a hula hoop, so that your arm also swings. This very gently stretches the shoulder joint and tissues.

Doorway stretch: Stand in a doorway with your hands on either side of the door frame, at shoulder height. Lean forward to give a nice passive stretch to the subscapularis," says Calabro.

Do stretches for between 10 and 20 times, depending on your comfort level.

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